Episode 237: Breaking the Injury Cycle (Part 3) - 6 Principles of Injury Management
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You’ve done everything you can to avoid injury. You focused on fueling and hydration, followed a well-balanced strength and conditioning program, removed intensity when needed, and diversified your training to include a multisport approach.
You leveraged all of the strategies Matt covered in the first two episodes of our three-part series on injury prevention and management.
Despite your best efforts, you now find yourself fending off the niggles and worry about it becoming a larger issue.
In our final segment on breaking the injury cycle, Matt moves beyond strategies for injury prevention and digs into the painful reality of coping with nagging injuries.
In this episode of the Purple Patch Podcast, Matt provides insight, based on patterns he has seen as a coach over many years, on how to avoid getting stuck in a cycle of injury and successfully emerge ready to train and compete.
Matt shares 6 principles that are important to apply a smart and pragmatic approach to overcoming the niggles and injuries.
Understanding Your Injury
(12:28) "If you're going to manage through any soft tissue, or even bone injury, it's really important that you spend the time to investigate what is actually going on, and how to manage."
Preventing a Niggle from Becoming an Injury
(25:55) "with tugs, or tightness, a general rule is to actually allow your body to do its thing. In other words, as I like to say, leave it the heck alone."
(26:27) "The body is really good at regressing to the mean, in other words, restoring, adapting, recuperating, and you don't want to intervene with that process."
Avoiding Detraining
(30:23) "You are a multi-sport athlete. And so we want to ensure that we double down and ensure that we don't de-train across the other elements. You are an athlete. And we need to ensure that we maintain an athlete mindset and approach almost every situation no matter what happens as much as we can."
Embracing the Four Pillars of Performance
(42:35) "When you do experience a little bit of a niggle or do have to navigate injury, you want to really double down on those two pillars, great nutritional support, and really focusing on destressing, and prioritizing sleep and downtime."
Following the Guidelines of Re-entry
(43:06) "The most harm, and an extension of an injury, tends to occur as an athlete has got over the initial symptoms and begins to actually progress back to regular training."
Leverage the Opportunity of Adversity
(50:41) "Every time that you face in a niggle or injury, there are always lessons to be drawn. And that is a part of growth, of becoming smarter about your body or developing autonomy, and in fact, a platform for you ultimately, to build resilience. "
Episode Timestamps
00:00 - 02:19 - Welcome and Episode Introduction
02:26 - 04:56 - Matt's News-ings
05:10 - 08:46 - Word of the Week
8:54 - Episode 237: Breaking the Injury Cycle (Part 3) - 6 Principles of Injury Management
Purple Patch Video Podcast and More
Episode 230: Breaking the Injury Cycle (Part 1) - 5 Keys to Prevention and Lowering Risk
Episode 233: Breaking the Injury Cycle (Part 2) - The Role of Nutrition
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Full Transcript
Matt Dixon 00:00
I'm Matt Dixon, and welcome to the Purple Patch Podcast. The mission of Purple Patch is to empower and educate every human being to reach their athletic potential. Through the lens of athletic potential, you reach your human potential. The purpose of this podcast is to help time-starved people everywhere integrate sport into life.
Matt Dixon 00:21
Hey guys, today we're going to be talking about the treatment of injuries. But if we want to prevent injuries in the first place, it's important that you build your performance recipe on a platform of health. One of the tools that we leverage to help athletes to find a platform of health is InsideTracker. And that's because the insights that we gain from your biometrics along with the advice from the team of experts InsideTracker, we get to create a precise strategy to help you develop your own platform of health. Now, you don't need to be a Purple Patch athlete to leverage the tool, all you need to do is head to insidetracker.com/purplepatch. That's insidetracker.com/purple patch. And you can use a code when you're there. Purple Patch Pro 20, that's Purple Patch Pro two zero. And guess what, you get 20% off everything at the store. Alright, enjoy today's show.
Matt Dixon 01:21
And welcome to the Purple Patch Podcast as ever, your host, Matt Dixon, and today we discuss injury it is part three in our three-part series around navigating that big topic that any athlete wants to avoid. In part one, we talked about prevention and some of the strategies that we could implement so that we can minimize our risk of getting injured in the first place. In the second part in the series, we welcomed Scott Tindal from FuelIn, a renowned nutritionist, and we dug into the role of nutrition as it relates to injury. But today, we're going to do a little bit of a case of the uh ohs. It's happened, you're injured. And I'm going to deliver some insights and information as a coach to help you manage and also emerge from injury. Now, this will be a cracker. It'll be highly valuable for you folks. But I hope that you're never going to have to use it because I want everyone to be healthy and injury free. But before we dig into the meat and potatoes, why don't we crack on with a little bit of Matt's News-ings.
Matt Dixon 02:26
Yes, quick bullets of news for this week. And well, it's kind of that time isn't it? We start to edge towards the end of race season, the World Championships start to look in the rearview mirror, we stride on and we start to look ahead and see winter looming. Well, let me tell you, now is the time if you're thinking about amplifying your strength programming. It’s a really good time of the year if you're looking to integrate the platform of training when you actually have less of a logistical and emotional overhead of looming races, this is a cracking time to integrate into what we call postseason. In fact, if you want to build performance for 2023, and the year ahead, from the ground up, now is the time it's all about habit creation, technique development, making sure that you're building tissue resilience, and formation of a whole bunch of education, and of course, a wonderful time to be welcomed into a great community. In other words, lay the platform for you to be your very best version of yourself. And so why don't we have a chat, all you need to do is ping info@purplepatchfitness.com and we can talk about how you can get involved with Purple Patch. And of course, Bay Area folk you folks that are around here in the Californ-i-a the west coast the best coast is the rumor. Don't forget the Purple Patch Performance Center is opening October the 20th. We are having a launch party. Lots of special guests, giveaways, and a chance to join us and celebrate. It is 4 pm to 7 pm at the new home of Purple Patch. Yes, right in the heart of San Francisco. Everyone is welcome. You don't need to be a Purple Patch athlete. And so if you are local, we'd love for you to come and check it out. In the bay area come along. If not send the invitation across to your friends or family or anyone that you think might benefit from our services. It's a lot of fun. It is an exquisite space that I am in right now. And we'd love to celebrate the opening after goodness me a good two and a half years of dreaded patience to get this place open and share it with San Francisco. And so yes, October the 20th. We'll leave the invitation in the show notes. But we're excited for everyone to celebrate with us. And with that Bazer, I know you'll be here. Maybe taking a little bit of a backseat role at that center launch opening, but at the same time right now you're going to get busy because it is time folks for Word of the Week.
Matt Dixon 05:10
Yes, guys Word of the Week. And it is this week. offseason? Yes, indeed that word. And guess what? That phrase offseason, it's dead. It is absolutely dead in the performance world. Gone are the days of you as an athlete turning your back on the sport, and turning to deep months of recuperation, rejuvenation, excess, and random training. The understandable instinct for many timestamped athletes is to, quote, take a break from structured training. And they want to do that so that they can focus their mind, on work, family, other aspects of life. But unfortunately, when you take a complete break from training, you also de-train and you ultimately set yourself up for greater risk of injury and poor results when you do turn the training focus back on. Guess what? There is a smarter and better way. Yes, a complete phase of less focused structure, but some high specificity, still shifting emphasis to that work and family. And that's good, that's valuable because it's healthy. But I think it's critically important that you don't turn your back on a framework and structure that can not only set you up for a great season of performance next year. But it can also underpin effectiveness across broader life and sport. I think it's highly valuable to maintain some structure with just a little bit of specific training, while at the same time still turning down the focus and the commitment level. You want to ensure that you retain the benefits of training structure while allowing space to become mentally and physically rejuvenated and amplify focus in other areas. What you execute in the coming months is all about preparation. That's why we call it a phase of preparatory training so that you lay the bedrock and can be set up to amplify the results over the course of the coming year. The nice thing about retaining structure, you remain organized, you have an opportunity to be effective across broad areas. On top of it, you're much more likely to retain some of the positive habits that amplify and improve your health, your effectiveness in the workplace. And then when you do turn back towards the sun, and your full attention goes back to your goals in your training, guess what your body is ready to absorb and adapt and optimize and get the yield from the hard work that you plan to put in. This phase, this preparatory phase, is the number one, the number one predictor when it comes to performance gains. Now, if you feel right now, that's too much to take in. If you're just desperate for a complete break, you're so fatigued from a year. It isn't the break that you need. But instead, you really need to visit how you've set up your training in the first place. And that is why I can say for your life, for your health, for your sports performance and on top of it a reduction of injury risk, our topic du jour, offseason is dead. And that is why it is our Word of the Week. Now speaking of injury, I think we need to get on with the show because we're talking about navigating through an emerging from little niggles. Let's do it, Barry, it is time for our meat and potatoes.
Matt Dixon 08:54
Yes, guys are meat and potatoes. And we have gone through a series of little discussions all orbing around the topic of injury. In the first episode, we talked about prevention. And we discussed post-workout fueling and the critical role of ensuring that that becomes a habit, making sure that your easy training sessions are really really easy so that you're not accumulating too much load. We discussed some of the benefits of multi-sport where you could actually even leverage for improvements in single sport training, and of course race performance. We delivered the backbone of a key strength and conditioning program. And of course, we discussed the art of backing off and removing intensity so that you could get in front of a niggle and ensure that it doesn't progress to become an injury. We then invited Scott Tindal on to the show and in the second part of the series we talked about nutrition, and in that episode, we discuss the role of hydration the role of each of the three macronutrients carbohydrates, fats, and proteins when it comes to actually prevention of injury, but also the management when injury does strike. We discussed at length, the common issues around undereating calories relative to your training demands. And of course, the importance of fueling the body with some really high-quality foods whenever you feel a niggle coming on. So now today, it's about getting into action a little bit. When we are actually feeling the impact of either muscular or bone injury. And this is really tough because we don't want you to feel this. Now, as we get going with today's show, I want to first put in a little coaching disclaimer, I should point out that I'm not here to provide medical advice today. I'm not a doctor, I'm not a trained physiotherapist. Nothing I say today is in the pursuit of trying to help you specifically navigate your particular injury. In fact, we're not going to talk about specific ailments or injuries per se today. This is purely a coaching lens of some of the patterns that I've seen over time. And some of the practical advice that I've given athletes to try and help them navigate little niggles and injuries. We aren't talking mostly about overuse injuries today. And so that's the lens that I'm looking through, we're not talking about impact, we're not talking about broken bones, we're not going to talk about stress fractures, either. We're talking about navigating soft tissue injury. That's the majority of the discussion today. Now, as I work with any athlete who navigates illness or injury, we tend to operate through the lens of cooperation and guidance being driven by any professional in their field that we need to draw in with support. And I suggest that you take on the same mindset. And so all I want to do today is try and deliver six guiding principles that I find really useful for any athlete to take on when it comes to actually navigating with that unfortunate niggle or hotspot. And so without further ado, let's dig in.
Matt Dixon 12:05
Remember six principles today and let's start with number one. Now, number one is a broad sense, this is going to be the one principle that probably has a little bit less direct, practical application, but I think is important. Principle number one is ensure you do all that you can to understand your injury. If you're going to manage through any soft tissue or even bone injury, it's really important that you spend the time to investigate what is actually going on, and how to manage. Now, as an endurance athlete, there are clearly a broad range of issues that can bubble up. And most of these issues ultimately come back down to the accumulation of too much stress on the body relative to its ability to adapt. And this can come from a variety of sources, it can come from training load. That's one component, and training load obviously is a ratio between intensity of training and the amount of higher intensity that you're putting in, and of course duration or commonly referred to as volume. So training load is a big bucket. That's typically the one that we look at first. But we should also look at a lack of adequate recovery and recovery can come in many forms. But it can be about post-workout interventions, downtime and rest, sleep, and rejuvenation. We also need to identify the role of nutrition and nutritional support. And of course, we can look at an accumulation of too much stress just relative to our specific weaknesses that we have as individuals, be it genetic or otherwise. But when we think about understanding our injury and trying to investigate and identify the source of that injury, I cannot overstate the benefit of having a true athletic-minded expert in your corner. Now there are wonderful experts, whether it's a physiotherapist, whether it's an orthopedic massage therapist, whether it's a doctor, whatever it might be, but it's ensuring that you build your network of really trusted resources. Some of these can be online. Some of them can, of course, be in person, and that's preferable, but you want to ensure that whoever you have in your corner when it comes to supporting you through an injury and providing advice, they really understand the life, the goals, the strains, and the journey of an athlete. It's a critical component. In fact, you almost want to segment out any advice from doctors that don't have an athletic lens. They might be fantastic doctors, but you need to identify as an athlete and put athletic-minded people in your corner. It's really important in fact, I'm tireless in my pursuit, more than any other arena perhaps, I am tireless in my support to surround myself with as many smart experts as possible around injury management. Now it comes around bodywork and tissue management, physiotherapist, doctors, whatever it might be. But as an ongoing journey, it's a really good component, that you build up your repertoire, your education, and your understanding from all of this body of experts. You want to learn from them. But then the first principle is, if and when injury does strike, you listen to them, you genuinely listening to their expertise. And you listen to their guidance and everything that they're suggesting. If I'm coaching an athlete, if we bring in a resource, it is the expert who is in control. My whole job is to support the athlete and implement the recommendations. And that is the same thing that you should look towards. That sounds really basic to begin, listen to the experts. But the truth is, this is really challenging for athletes to do, particularly over the longer term, to see the journey through to follow their recommendations and ensure that you go through the journey. If you have any niggle or injury, by following the practical advice of someone that sees injuries all the time, understands the progression, and is trained in the journey back to full health. If you actually execute everything they're asking you to do, you have a much higher likelihood of not only healing as quickly as possible but reducing the risk of injury, repetition. And so ultimately, as you become more resilient, it comes from patience, learning, and then of course following doctor's orders. I think that is an important principle that we should lean on first. This might sound really obvious to you. But over time, what starts to happen if you lean into experts is you start to appreciate and understand the different types of injuries. And with that, you can start to become a little bit more autonomous. And you can in fact, even sometimes get in front of injuries. Let me give you a couple of case studies. Let's take a common injury, a hamstring tug. Now the hamstring at the back of the leg, that muscle there, tends to be a little bit weaker than the large group of muscles, the quadriceps, that make up the front part of the leg. And it's pretty common for athletes, particularly endurance athletes, to experience some niggles and pains some tightness back there in the hamstring. Now that would be a muscular strain. And it's often occurring, the symptoms that you feel tightness niggles pain in the hamstring, it's actually often occurring because of an overload of the muscle, from a weakness or an issue further up the train, often in the low back the hips, and around that area. And so if you're experiencing some tugging, some tightness, it's muscular. And the correct course of treatment, there is rest rejuvenation, the tendency or the inclination for many athletes, is to stretch it. But what you don't want to do is intervene too much with a muscular strain. It needs rest, you don't want to beat it up, you want to as I like to say, let it breathe. This is an area that has plenty of blood flow. And so generally leaving it alone little bit more and not trying to stretch that hamstring tends to allow the muscle to restore to the mean in other words, release and get healthy. And so unless it's a really deep tear and we're talking about just a little niggle a little tightness here, over 48, 72 hours, often that muscle can just breathe and return back to normal. That becomes really important. You learn that type of thing, just by looking and reviewing and learning from experts in their field who have that wisdom before.
Matt Dixon 19:10
But let's look at a different case point. Let's look at the low blood flow area and some common niggles that maybe a lot of runners get I can think of a couple here plantar fasciitis, if you've had plantar fasciitis, you know, it is not a fun thing to go through, or a little bit of a strain around the Achilles tendon, both really frustrating injuries to go through. So in my recommendation, my global recommendation of leaving the hamstring alone and muscle injury, it's a little bit different when you have low blood flow areas and you learn this from experts, because both of these injuries actually require, in order for you to heal, a little bit of activation. They actually need some load. And you want to do this under some guidance and some expertise. But you want to think about these injuries. is a little bit like a rubber band, and we need them to heal to remain a little bit malleable. If you leave a rubber band alone, it just gets old, it starts to get crusty it starts to get stiff. And that's what happens. If you just say, I'm going to rest plantar fasciitis, I'm going to rest the Achilles, it doesn't tend to heal very well. And so under guidance, those injuries actually require a little bit of load and activation because we're seeking malleability and movement. And so there's an example on the other end of the continuum, that pure rest isn't going to actually fast track recovery.
Matt Dixon 20:38
Now, these examples don't offer a pathway for you to emerge from every single injury. But what they do is just cast a light on the type of learnings that you can lean into and start to build into your repertoire so that you can become more sensible and autonomous in treating your own injuries or niggles, and that becomes really important. So before we get going on the more practical guidance, let's just establish that we want to ensure that as an ongoing practice, leaning into education around injury management is a really, really good thing for us all to do, coaches and athletes.
Matt Dixon 21:17
And with that in mind, let's get on with principle number two, and let's get a little bit more practical because principle number two is one of the most common mistakes that I see athletes make, unfortunately, kind of all time. I want you to be careful not to convert a niggle into an injury, so niggle we can classify it as a sensation of a little bit of symptom of pain or tugging or tightness. An injury is something that is truly preventing you from participating in one of the disciplines of your sport. Okay, so it's a real thing. So with a niggle, that's the first sensation that you feel. Oh, uh oh, I feel a little bit of tightness in the calf, a little bit of tightness in the hamstring, whatever it might be. Something that's there, but something that hopefully we can navigate through and get returning back to normal training with it evaporating into the back of mind as quickly as possible. Many athletes unfortunately do a stellar job of a conversion of niggles to injuries. And of course, we don't want that. Let me tell you a little case study here. And I tell you about John. So John goes free run, very good run. But halfway through the run, he starts to feel a little tugging in his calf, and he finishes the run, and he's worried. That calf remains tight. Oh no, he thinks not another calf injury. I've got a repeated cycle of this. I want to get through this. (mimicking bugle call) it is time to bring in the cavalry. And so all day, what John does is he leverages every single opportunity he has to drop into position, to drop down his heel, lean forward into a wall, and stretch that calf. He is willing the calf to release its tight, I need to get it back to be malleable. On top of that, John prods and massages and digs at the calf breaking apart that tightness. I know that massage therapy is very good for me. And so I'm going to take it on with these magic thumps and dig in there. He isolates his foam rolling that he loves to do for seven to 10 minutes every day but he focuses like a bullseye onto that calf. He even pulls out the magic massage gun, the thing that was going to be the tool to prevent every injury. And he hammers his calf up and down watching television. After dinner before bed, when he wakes up in the morning, prod push massage, stretch, rinse and repeat. And before he knows it, John is injured. And so it goes on.
Matt Dixon 23:56
Now, of course, what happened here is John felt a symptom, that tightness when he ran, and it was in the calf. But within 48 hours, John's burdened with a full-blown calf complaint. And this cycle often occurs with athletes with little niggles all over their body. And from the symptoms. What they have done, just like John, unknowingly, is to create so much trauma at the site, and such a great amount of inflammation that actually greater issues emerge.
Matt Dixon 24:32
So what are the simple lessons from this? Well often the symptom, the actual symptom that you feel in John's case it was that tucking and it could be a little bit of pain, a little bit of inflammation. But it's important to remember that that symptom isn't necessarily the source of the issue. So where we actually feel pain or fear or tightness, it might not be at that spot. There is actually the source and the cause of it. And that becomes really important when we think about how to intervene. Now, any intervention typically is a guidance from this, it is better for you to actually intervene around the symptom, rather than at the source of the symptom. So in John's case, if he's feeling a tight calf, it's better to start with a little bit of work around the foot and the planter, going up with the hamstring, the quads all the way up to the lower back, but where he's feeling pain, you probably actually want to leave that site alone. For the most part, it's really challenging to do so. But it's a smart approach to do it. Okay, that's really important. Any intervention that you want to do, wrap it around the source of the symptoms, don't go driving right at the symptoms itself. Now, in John's case, with tugs, or tightness, a general rule is to actually allow your body to do its thing. In other words, as I like to say, leave it the heck alone. This is really counterintuitive for athletes. But there are things that you can do, you can reduce training loads a little bit, particularly removing intensity from that training load. What you're looking to do, is to let that tightness or that inflammation, breathe a little bit. The body is really good at regressing to the mean, in other words, restoring, adapting, recuperating, and you don't want to intervene with that process. What you can do is reduce training, load, and then maintain your regular prehabilitation exercises and routines that you do foam, rolling, stretching whatever fits into your repertoire, but maintain it over the course of the whole of your body. Because again, you don't know what the source of those symptoms are. If you need to, you can replace training that's causing the aggravation. In John's case, it was running very clear, Amplified, some tightness, you maybe reduce or remove running, but you can remove it with other or replace it with other sorts of training. And then you want to give it 24, 48, 72 hours rest without judgment. And quite often, if you get it early enough, and you're brave enough to do that, that little tightness will just dissipate. Your fingers can be weapons of inflammation. In other words, they can create more trauma than you realize. And so instead, I really encourage you as a general rule to be nice to the tightness and put it in a really comfortable environment, I would lean a little bit less into ice baths, and ice compressions, leaning a little bit more into a nice hot bath, let it breathe, and then it's 72 hours. If it's still there, then you won't be maybe want to take the next action and potentially reach out some professional advice to get some guidance on what you can and should do. Now, what I'm discussing here, remember, is a specific site of tightness or soreness. So we're talking about really isolated sore spots. What I'm not outlining here is a case for some of the global stiffness that you might experience from maybe muscle trauma from a really hard run session, like coming off a track or doing an extra long trail run whatever it might be. That's not what we're talking about here. What we're talking about is a symptom of a niggle pretty simple for you and really important. And so the big lesson out of this one, your body is a healing machine. And so you don't always need to think that your nonexpert fingers and some obsessing, stressing are stretching are the things that are going to assist it. In fact, they are often the things that can get in the way and cause injury. And we don't want that of course.
Matt Dixon 29:03
All right. Principle number three folks, your injury or niggle shouldn't mean de-training. This becomes really important. But it is going to require some out-of-the-box thinking quite commonly. Yes, we need to set up a strategy that if a niggle does become some form of slightly longer-term injury. We need to do everything in our power to keep you trained. You are an athlete, your body requires load and in whatever form, we want to try and ensure that we can keep some load so that we can keep you functional and healthy as an athlete. This becomes really, really important. And it becomes a little bit of a paradox for people, but at the specific source and site of injury, we quite often need rest. We need to ensure that we're not aggravating it or delaying recuperation. So we need to be isolated in our thinking that we need to give it breathing room, we need to give it rest. We don't just blindly train through it. And so quite often, let's use a triathlete as an example, we might need to remove running, the weight-bearing exercise because that's causing the injury and the symptoms and the sensations. But you are a multi-sport athlete. And so we want to ensure that we double down and ensure that we don't de-train across the other elements. You are an athlete. And we need to ensure that we maintain an athlete mindset and approach almost every situation no matter what happens as much as we can. And this really highlights the power of a multi-sport lens. Single sport athletes have a greater challenge with this. But even single sport athletes are starting to work out the power of actually leveraging other disciplines, not just becoming a triathlete, but leveraging other disciplines so that they can get ready for their single sport race. And so I really encourage you, if you do experience a little bit of a niggle, or you're navigating injury, stay with an athletic mindset and look for opportunity. Let me tell you a little story about Jenny. So Jenny had a knee issue, she was a triathlete, she had a knee issue. And as I mentioned before, that's something that can take you out of running a little bit while in fact, she went several weeks where she could do zero running whatsoever. And that was because of the impact of landing, when you're running multiple times your body weight is sinking into the ground, and your body has to absorb it. And that was causing real pain and trauma to around the knee. And so we had to remove running, to enable adaptations, recovery, and of course, a restoration of full health. So now it was time to think out of the box, I can't do running. That's of course, the natural focus. Goodness me, Jenny thought I'm gonna go backward. But we need to get creative. And you can always get creative. This provided an opportunity. And that was for Jenny, really focusing on swimming, a non-weight-bearing sport. That can elicit some cardiovascular conditioning. That was a weakness for her, so she could work on a weakness and actually improve that without the interruption of that muscle waiting, fatigue-inducing, running, and let's really, really focus on swimming. She could also double down on her bike training. Now that included some very, very carefully prescribed lower cadence, higher torque work, stuff that can actually amplify the musculoskeletal system, but didn't actually impact the knee. And then even further out of the box, we started to implement some out-of-the-box thinking around some weight-bearing activities. For Jenny. It was Hill based walking, absolutely massive load bearing strength based,
Matt Dixon 33:03
a great pushing exercise working on the posterior chain, all of the elements that come into improved running form, and making sure that we maintain tissue resilience and muscular load without risk of niggles on that knee. The final thing that we implemented was something a little bit crazy. But we integrated some rowing ergometer work. A leg-driven sport, but once again, not causing trauma on the knee. And so we got to carry on training. And ultimately, over the weeks, Jenny stayed really, really fit progressed in swimming, did some highly valuable bike riding without the fatigue-inducing components of running. And then when we were ready to integrate running back in, she remained healthy. She had progressed as an athlete, but in addition, could then implement running back in and move right back to a more common perception of what it means to be a triathlete. And so yes, injury can provide an impact on your ability to train. It often produces restrictions, but it doesn't prevent performance progression. And this is really important. Because while we want to prevent as a coach, you as an athlete, and your experts that are supporting your us as a team, we want to ensure that you don't fall into what we might call injury cycling. Now, this has nothing to do with bike riding whatsoever, but it's an athlete that falls into this common cycle of always being injured. So what I mean by that, well, you get a niggle, you get a niggle that progresses to an injury. And so you rest goodness may that may kill his game. I'm going to rest and it goes away. And so you'll give the body the rest so that the body can rejuvenate but at the same time, globally, you are de-training. You're losing the integrity and the resilience of your tissue and your muscles, your cardiovascular conditioning is dropping. And so you have effectively detrained. So now you return to training, more ambitious than ever before. Having a little bit of a makeup mindset being frustrated that so much of your season so far has been derailed, and you charge into the next progression, and another injury pops up.
Matt Dixon 35:26
Now you've done your left hamstring, goodness me now I need to rest, again, restore, rejuvenate, and you detrain further and you return again. And once again, the tissue around your knee gets injured, and you fall into this cycle. And so those cycles continue and suddenly you are labeled as an injury-prone athlete. Repeating injury cycles are often due to detraining related to rest and recovering from injury. And so we need to make sure that we don't fall into that cycle. I cannot overstate how important this is. You need to try and do everything you can to maintain performance progression when an injury strikes. And if you can do that. And then it's high value.
Matt Dixon 36:10
Now, one other point that we should say under this principle, that's important. While we do want to maintain training, and it's important that we keep a mission of performance progression. But with that, we need to ensure that we're not being stubborn or silly when it comes to those niggles and injuries, because of a risk that we have when we are carrying some form of niggle or injury is that we create what we call compensatory injuries. Now a great example of this is maybe you've got something going on in the lower extremity of the right leg. And so you maintain training, but you end up having an injury in the left leg. Let me give you a real example with an athlete that we had many years ago. This becomes really important. We're going to talk about Rachel. Now Rachel was a wonderful athlete an elite athlete, professional athlete, and she got a very nasty cut on her right foot. And that removed her ability to really run properly. So we know it's very important. Rachel doesn't want to detrain, we've got to keep progressing. In fact, we were getting ready for a world championship. And she started to be able to run a little bit. But there was a little bit of compensation going on, she tended to actually protect the sight of the cut. And she rolled out, without us really realizing, rolled out and tended to run on the right side of the outer part of her right foot. And so that changed, barely perceptible. But it changed her gait. So what happened there, of course, within three, four, or five weeks, suddenly her left hip was getting tight. And now we had a different issue. And that was something that we had to manage and navigate. But that's a great prime example of a compensatory injury, an athlete that has an issue on one side. And because of a shift in mechanics or an emphasis in a protection quality on the other side, then there is too great of a load for that left side in Rachel's case to actually absorb. Now the good news is Rachel being an incredibly smart and brave athlete that she managed to navigate through, still went on to get healthy, went into the World Championship, not overly trained, that's for sure, and still managed to get a top five placing. But this is a very common issue and at least something to be aware of when you think about it.
Matt Dixon 38:32
All right, so let's pause a little bit less reflect on what we've gone through. So far. The first principle we talked about is understanding your injury really important, and then trusting and not only trusting but following the orders of an expert, super, that's a great principle. Number two principle was making sure that you don't become your own worst enemy. In other words, all that prodding and stretching, and over-worry that creates an ambitious intervention on the first sign of trauma often is the thing that creates a full-blown injury. So that's worth us understanding that. And then finally, if a niggle or injury does strike, we want to do everything that we can to maintain progression of athletic performance progression. And so that becomes a whole mission to avoid detraining. Good. With all of those in mind. We're halfway we've got three to go.
Matt Dixon 39:28
Principle number four. And this is where we get to talk about the four pillars of performance. So as a reminder, when I think about athletic development, we always think about an equal philosophical playing field between your endurance training, your strength and conditioning, your recovery, and everything that falls undernutrition. And when we look at those four things, those four pillars that we're talking about it from an educational standpoint, that makes up an athletic program. Now, of course, you as an athlete are going to naturally focus mostly on the work side. Because that's where you're getting all your validation, that's laying out the plan. That's where all the emotional side of training comes. The endurance pillar. And we also intuitively understand the important role of everything that fits under functional strength and conditioning. Mobility, stability, strengthening, etc. But strength in that pillar is often positioned as the standalone fix for everything that is injuries. And that's not the case, it's just one component in the recipe for you to become more robust, more resilient, and more equipped to actually navigate any injuries as they strike. But the reduction of risk of injury and emerging from it truly requires a broader perspective than this. And it's a focus on all four pillars, let's label endurance because we've sort of took it off on that, we have an appreciation of the role of strength and everything that fits behind it. But it is critical that we have a heavy emphasis on the caloric support that can facilitate healing. So that's ensuring that when you get a niggle or injury, you maintain enough calories, you don't just go on some strict diet, those calories are of a high caloric choice. So lots of vitamins, minerals, proteins, and fats, et cetera. And you keep the muscular cells and the cellular system really hydrated because that's how your body operates best. And so we want to double down our emphasis on really eating and drinking well. And then finally, there is, of course, the big pillar of recovery. Now, my label is the recovery coach. But we're going to facilitate recovery, in this case, mostly from rest, downtime, and sleep. Those are your most powerful adaptation tools.
Matt Dixon 41:57
It's not the magic gun. It's not the big compression boots, it's not the funny pair of socks that make you silly, look very silly in an airport, it is downtime, rest, and sleep. In fact, they say your training adaptations occur mostly at sleep. And that's true, but so does your healing. Because in many ways, injury repair is adaptation. And so you can't expect a great rate of injury repair, if you're consistently overstressed and underslept. And so principle number four is when you do experience a little bit of a niggle or do have to navigate injury, you want to really double down on those two pillars, great nutritional support, and really focusing on destressing, and prioritizing sleep and downtime. Pretty simple. Yeah, but it's really critical.
Matt Dixon 42:53
All right, so we are down to the last two, I want to dig into your guidelines of reentry. Now, the reason I think that this is a guiding principle is because the most harm and an extension of an injury tends to occur as an athlete has got over the initial symptoms and begins to actually progress back to regular training. And it's understandable because most of us have athletes are pretty low on the patience scale. We've been off the field of play if you want to call it that we haven't been able to train. And we are ambitious and goal driven. And so it's no wonder that we go from 2 to 10 out of 10 as quickly as we can. But unfortunately, injury doesn't like that. Tissue doesn't work like that. We need to be really pragmatic and patient on the re-entry to full training. This is not a black-and-white situation. Seldom are athletes either injured or not injured. It's a dirty, murky, dynamic molding world. And it really requires some flex and a little bit of pragmatism. So our whole guiding principle when it comes to little niggles or injuries is for the aim for you through every experience to, a phrasing that I love, emerge stronger. Now there are three main phases that we tend to go through when it comes to injury. The first is the pure recovery part of the process. And that's where a lot of the restoration, the adaptation, the symptom removal starts to occur. Then there is the second element, the place where so many athletes go wrong, which is the progression from that real rest around the site. Symptoms really dissolving back to being training ready.
Matt Dixon 44:48
And this is the little process depending on the niggling injury, the one that can take a long time, but it takes a tremendous amount of patience, and it's the toughest part mentally. You're not getting any simple without any more from your friends and family or coaches. Most of your symptoms are dissipated. But the journey between going from where you're at right at that point back to the capacity, or the ability to absorb full training load, and that in itself is a journey. And it becomes incredibly important. And I can't overstate how important that process is. If you nail that journey multiple days or multiple weeks to get back to full train readiness, and then the chances of you regressing and getting injured on that same site again, are dramatically reduced. Once you get on there, and then you can train towards performance readiness. And that's where you go back to regular training with it evaporating into the back of your mind, and you're driving now looking forward to your upcoming goals or events. Becomes really, really important. And still, then we want to make sure that we ease back in. So to highlight this point a little bit. Why don't we return to our friend John, do you remember him, the guy with the calf niggle? Well, let's rewrite history a little bit. Imagine that John managed to avoid that trauma event, he didn't use his fingers as weapons of trauma. Instead, he left that tight calf the heck alone, he stopped running for a couple of days, he slept really well. He ate plenty of high-quality food, he enjoys a nice hot bath, he maintained swimming and cycling. In fact, he added a couple of swims, and guess what happened, the calf released, the symptoms dissipated. And he thinks goodness me, I dodged a bullet. But you didn't just dodge it, you were really smart in your pragmatism. And so in general, for that type of small twinge and niggle, there's going to be a process that you have to go through. Many athletes -- there oh symptoms relief, let's turn it back on. And that's when issues can occur. But now we're gonna paint John as a little bit smarter. Because this is what John would do. Our smart version of John. Symptoms have dissipated, pain is under a four out of 10, he feels pretty good. On day one, he's not just going to go for a 60-minute run. Instead, he's going to do a run-walk protocol. And it might be something as simple as walking for five or 10 minutes and then doing a couple of minutes of running, followed by one minute of walking, and repeat that two or three or four times. And then what he would do is he will wait and he'll see. And he won't overstretch and he won't prod because he's learned his lessons. And if the sensation of pain, while he's doing that run walk, is less than a four out of 10 effort, he's pretty much good to go, it's not too bad. He shouldn't expect to be completely sensation free, it's very common that you might feel a little tightness a little almost phantom sensation. And that can be brought on just simply because you haven't done much. And your brain is hyper-focused on that component of your body. And so when he wakes up the next morning, he shouldn't have regressed at all. And if he gets that little flag, I'm all good. Then after assessing, he can then be cleared to maybe do a little bit more of an easy run, what we might call a soul-filling run. Now, John being smart, he might still implement some walk breaks, but he might actually move up to a 30 or 40-minute run. After all, this isn't a full return from running injury. This is just a little twinge and sensation that he decided to get in front of and give it a little bit of breathing room. So he goes and does an endurance day, not too hard, no intensity, not too long, still integrating some walking. Now he's three days, 72 hours. And so he's had two cycles or 72 hours, leaving it the heck alone for 72 hours, reentry to training readiness over 72 hours.
Matt Dixon 49:09
Day three, he's still doing endurance activity. He's not introducing intensity and running. He's keeping it really calm. And he's having a good validating experience. And now he's got a body of experiences in which he is pain-free and symptom-free. Good. That means on day four, he's clear and he can probably return to training. Now the next 72 hours, we're gonna think about it in two blocks, symptom removal, rest recovery, let it breathe, as I call it. Now move in the next 72 hours as a return to regular training. And we can use different injuries depending on your injury, the length of time this might extend to multiple multiple weeks if we're talking about coming back from a bone injury, but that phase of training is so important and so critical for you to implement.
Matt Dixon 50:02
Alright, so I've equipped you with five principles. Why don't we bookend with one final piece of broad advice? And that is if you do face injury, if you do have a little bit of a niggle, guess what, just like really stressful situations or times of an accumulation of too much load, there is always opportunity. And so with this adversity, I really encourage you to always seek opportunity. Why is this occurring? What's actually the root cause of this? How can I correct my behaviors or my approaches? What are my opportunities, because every time that you face in a niggle or injury, there are always lessons to be drawn. And that is a part of growth, of becoming smarter about your body or developing autonomy, and in fact, a platform for you ultimately, to build resilience. The most extreme example of this is a Purple Patch, professional athlete, one of my favorite athletes that I ever coached, Sarah Piampiano. Now, this sounds quite traumatic, but I'm going to leave you with this story today. Several years into coaching Sarah, she had a traumatic injury, a fractured femur, and it wasn't because she was having a bike crash or getting hit by a car, it was an overuse injury. Now, that's not a niggle. There was a bone injury, a stress reaction that moved into a full-blown stress fracture. This is a catastrophic injury. It's going to involve some forced deep training and it is a longer-term injury. Months of healing, and then a very long progress or journey back to train readiness, and then another journey back to full race performance readiness. And so we're talking 18 months to two years here. For a professional athlete, it is emotionally devastating as a coach, and an athlete is particularly challenging to navigate. And so this was a step back. But at the same time, it presented an opportunity for Sarah, because there is always opportunity. And so in Sarah's case, as smart and as brave as she is athletically, in that time of healing, there was little that we could do. She was in a wheelchair, she was moving on to crutches, there was next to no activity that she could navigate. So all she could do is let her body rest and rejuvenate. So let's treat that as a break. While we knew it was going to be detraining. She had been training and racing very, very hard for several years. And so let's hope, let's hope that that gives her body a chance to systemically really reheal. And on top of it, giving herself a mental break from the rigors of being a professional athlete. But while no training could occur as a professional athlete, instead, what she focused on, were her sponsors, her brand, her relationships. And of course, her mind.
Matt Dixon 53:13
She studied, she decided to give back to her community, she started to mentor some junior professional and upcoming athletes. And giving yourself to something or someone is an empowering activity. And that drove her purpose and it also formed tighter relationships with her sponsors. And that was great. Because by taking that approach, there was less of a woe is me, goodness me what's happened to my career. And in fact, Sarah just grew in her perspective. And that set her up for a later emergence into really, really strong relationships that she could lean into when she was ready to return to full competition. The second part of her journey becomes really empowering was then the progression back to training. So she was off crutches. And now we could start move her back towards being a professional athlete. And that was a process that probably took six months or so. That was an opportunity for Sarah to completely reinvent herself. What we did is we sought back and really investigated what was some of the contributing causes. Never looking for the villain in this but what some of those contributing causes were that actually led to this stress fracture. And so there was components around her training structure that I could learn. Some of the habits and some of the mindsets and maybe some of the weaknesses of approach. And Sarah did a fantastic job of applying those lessons, removing some of the contributing traits and developing habits that we believe would really set her up for success. On top of that, she took on a ground-up focus on strength and condition. She wanted to reinvent herself and work on what we call the chassis. That became a really important component, while at the same time developing a heavy emphasis on swim - nonweight bearing. That was Sarah's weakness. Let's develop cardiovascular conditioning in the area that your weakest and from the ground up when she did reenter running, let's do it with a heavy focus on technique and form. And so as she went through that process, and then finally could take on the last part of her return, which was the progression to actual race performance, she had new habits, a stronger more resilient frame, she had worked on a weakness to develop running form. And she had on top of it all became a smarter athlete in the Art of Racing. And with that, 18 months later, she could identify a return to a professional athlete, but on top of it a better pro. And from that point on, that was the catalyst that enabled her to truly enter world-class performance, multiple Ironman victories, multiple top 10s at the Hawaii Ironman, the second fastest American finish in an Ironman ever. And it was because of that adversity. But more than that, because of Sarah's approach to that adversity and the relationship they developed that ultimately became the catapult that sent her into the great professional athlete that she was. Now, you might not have sponsors, you might never win an Ironman. But what you can do is apply a smart and pragmatic approach to navigate niggles and injuries. And so I hope that helps. I'll speak to you next time.
Matt Dixon 56:49
Guys, thanks so much for joining. And thank you for listening. I hope that you enjoyed the new format. You can never miss an episode by simply subscribing. Head to the Purple Patch channel of YouTube, and you will find it there and you could subscribe. Of course, I'd like to ask you, if you will subscribe, also share it with your friends. And it's really helpful if you leave a nice positive review in the comments. Now any questions that you have, let me know feel free to add a comment and I will try my best to respond and support you on your performance journey. And in fact, as we commence this video podcast experience, if you have any feedback at all, as mentioned earlier in the show, we would love your help in helping us to improve. Simply email us at info@purplepatchfitness.com or leave it in the comments of the show at the Purple Patch page and we will get you dialed in. We'd love constructive feedback. We are in a growth mindset as we like to call it. And so feel free to share with your friends. But as I said, Let's build this together. Let's make it something special. It's really fun. We're really trying hard to make it a special experience. And we want to welcome you into the Purple Patch community. With that. I hope you have a great week. Stay healthy, have fun, keep smiling, doing whatever you do. Take care
SUMMARY KEYWORDS
injury, athlete, niggle, training, running, important, symptoms, little bit, tightness, bit, navigate, ensure, rest, hamstring, load, experts, performance, principle, patch, calf